The Neutrophil-to-Lymphocyte Ratio Determines Clinical Efficacy of Corticosteroid Therapy in Patients with COVID-19

• DOI: 10.1016/j.cmet.2021.01.002
• Publication Date: 2021-01-10T00:52:26Z
• Authors: Jingjing Cai; Haomiao Li; Changjiang Zhang; Ze Chen; Hui Liu; Fang Lei; Juan-Juan Qin; Ye-Mao Liu; Feng Zhou; Xiaohui Song; Jianghua Zhou; Yan-Ci Zhao; Bin Wu; Meiling He; Huilin Yang; Lihua Zhu; Peng Zhang; Yan-Xiao Ji; Guang-Nian Zhao; Zhigang Lu; Liming Liu; Weiming Mao; Xiaofeng Liao; Haofeng Lu; Daihong Wang; Xigang Xia; Xiaodong Huang; Xiang Wei; Jiahong Xia; Bing-Hong Zhang; Yufeng Yuan; Zhi-Gang She; Qingbo Xu; Xinliang Ma; Yibin Wang; Juan Yang; Xin Zhang; Xiao-Jing Zhang; Hongliang Li
• Keywords: Physiology; Neutrophils; Medical Biochemistry and Metabolomics; Severity of Illness Index; corticosteroids; Endocrinology & Metabolism; 03 medical and health sciences; Clinical Research; neutrophil-to-lymphocyte ratio; Adrenal Cortex Hormones; Risk Factors; inflammatory status; Diabetes Mellitus; Humans; Lymphocytes; Molecular Biology; Metabolic and endocrine; Proportional Hazards Models; 0303 health sciences; SARS-CoV-2; Diabetes; Evaluation of treatments and therapeutic interventions; COVID-19; Cell Biology; Clinical and Translational Report; Length of Stay; mortality; COVID-19 Drug Treatment; 3. Good health; Survival Rate; Good Health and Well Being; Treatment Outcome; Diabetes Mellitus, Type 2; ROC Curve; 6.1 Pharmaceuticals; Area Under Curve; Hyperglycemia; Patient Safety; Biochemistry and Cell Biology; Type 2

Corticosteroid therapy is now recommended as a treatment in patients with severe COVID-19. But one key question is how to objectively identify severely ill patients who may benefit from such therapy. Here, we assigned 12,862 COVID-19 cases from 21 hospitals in Hubei Province equally to a training and a validation cohort. We found that a neutrophil-to-lymphocyte ratio (NLR) > 6.11 at admission discriminated a higher risk for mortality. Importantly, however, corticosteroid treatment in such individuals was associated with a lower risk of 60-day all-cause mortality. Conversely, in individuals with an NLR ≤ 6.11 or with type 2 diabetes, corticosteroid treatment was not associated with reduced mortality, but rather increased risks of hyperglycemia and infections. These results show that in the studied cohort corticosteroid treatment is associated with beneficial outcomes in a subset of COVID-19 patients who are non-diabetic and with severe symptoms as defined by NLR.